Individual
MICHAEL FUNKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6410 FANNIN ST, SUITE 732, HOUSTON, TX 77030-3000
(713) 500-7103
(713) 500-0530
Mailing address
6410 FANNIN ST, SUITE 732, HOUSTON, TX 77030-3000
(713) 500-7103
(713) 500-0530
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
44459
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44459
TEMPORARY INSTITUTIONAL LICENSE, TEXAS MEDICAL BOARD
TX
Enumeration date
06/02/2014
Last updated
06/02/2014
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